Acetaminophen use in patients who drink alcohol: current study evidence

Limiting or avoiding alcohol can help, and talking to a healthcare professional can provide more information and treatment options. Alcohol use disorders can result in many physical, psychological and social effects, from weight gain and liver dysfunction to domestic violence, loss of income, unemployment and damage to unborn children. Understanding alcohol use and seeking available resources are instrumental ways to diminish the influence of alcohol. Drinking large quantities of alcohol can induce acid reflux because it relaxes the muscle located between your stomach and esophagus, and will cause a burning sensation in the back of your mouth. Alcohol combined with gastroesophageal reflux drug can make heart burn worse.

If you or anyone you know is undergoing a severe health crisis, call a doctor or 911 immediately. Isaak learned addiction psychology at Aspen University and got a Master’s Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

The activities of these enzymes may vary from person to person, contributing to the observed variations in alcohol elimination rates among individuals (Martin et al. 1985). (A) Alcohol ingested through the mouth reaches the stomach, ketamine detox symptoms timeline medications and treatment where a portion is metabolized by the enzyme alcohol dehydrogenase (ADH). The remaining alcohol enters the intestine, where most of the remainder is absorbed into the bloodstream and enters the portal vein that leads to the liver.

  1. In a recent study by The Recovery Village, we asked over two thousand people about their alcohol use.
  2. Alcohol that has not been eliminated by first-pass metabolism enters the systemic circulation and is distributed throughout the body water (i.e., the blood and the watery fluid surrounding and inside the cells).
  3. Fasting increases paracetamol hepatotoxicity in rats by decreasing glucuronide and sulphate conjugation so that the proportion converted to the toxic metabolite is significantly enhanced [116].
  4. Before taking acetaminophen, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
  5. Consuming both at the same time can essentially force your liver to work overtime and make it harder for this essential organ to perform its usual functions.
  6. Isaak learned addiction psychology at Aspen University and got a Master’s Degree in Arts in Psychology and Addiction Counseling.

When combined with diabetes medications, which also do the same thing, the lethal combination can cause your blood sugar to drop to very dangerous levels. Oral contraceptives tend to retain alcohol in the body for longer periods of time, which means that women who take the pill are quick to become intoxicated when they drink alcohol. While this will not negate or alter the effects of the medication, the prolonged alcohol retention can mean impaired decision-making and reduced sexual inhibitions. Acetaminophen is an ingredient in over 600 pills in the US alone, including prescription and over-the-counter drugs. It is important to note that this is not an exhaustive list, and that there are many other pills that contain acetaminophen. It is always best to check the labels of the pills you take to be sure of their contents.


NSAIDs can make you sick, too, but it takes a larger amount to reach a dangerous overdose. Taking too much acetaminophen can damage the liver, sometimes leading to a liver transplant or death. Acetaminophen overdose can cause acute liver damage, failure, and death in the most severe cases. A 2016 review highlights that the risk of acetaminophen-induced liver damage is higher for individuals who have AUD and also overdose on acetaminophen. When alcohol enters the picture, it increases the activity of CYP2E1, so the body produces more of the NAPQI toxin. Alcohol also decreases glutathione production, meaning NAPQI is more likely to build up in the liver in dangerous concentrations.

Reducing the Risk

In the liver, part of the alcohol is metabolized by ADH or cytochrome P450. The remaining alcohol enters the general (i.e., systemic) circulation and eventually is transported back to the liver and metabolized there. The metabolism of alcohol in the stomach or during the first passage through the liver after absorption from the intestine is called first-pass metabolism. (B) Changes in blood alcohol levels (BALs) alcohol as a seizure trigger after oral alcohol ingestion and after intravenous administration of the same alcohol dose. Diabetics who consume alcohol also must be alert to the fact that the symptoms of mild intoxication closely resemble those of hypoglycemia. Finally, patients using certain diabetes medications (e.g., chlorpropamide) should be cautioned that the medications can cause a disulfiram-like reaction when alcohol is consumed.

Thus, MAO inhibitors (e.g., phenelzine and tranylcypromine) can induce severe high blood pressure if they are consumed together with a substance called tyramine, which is present in red wine. Accordingly, people taking MAO inhibitors should be warned against drinking red wine. The atypical antidepressants (i.e., nefazodone and trazodone) may cause enhanced sedation when used with alcohol. SSRIs (i.e., fluvoxamine, fluoxetine, paroxetine, and sertraline), which are currently the most widely used anti-depressants, are much less sedating than are TCAs.

The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication. This means that a moderate amount of alcohol (one drink a day for women and two a day for men) may be safely mixed with Tylenol, but you should still take caution to limit your use of both Tylenol and alcohol when combining the two. Dr. Gray says the maximum recommended dose of Tylenol per day is 4,000 milligrams, and that it’s generally safe to consume a moderate amount of alcohol as long as you’re keeping your Tylenol dosage under that. The hitch is that acetaminophen also has a narrower window of safety compared with ibuprofen and naproxen.

Acetaminophen and Alcohol

In contrast to the findings in animals, chronic alcoholics do not produce abnormally increased amounts of the potentially toxic metabolite of paracetamol. There is only modest, short-lived induction of CYP2E1 in chronic alcoholics and it seems that other isoenzymes are primarily responsible for the metabolic activation of paracetamol in man. In keeping with the metabolic data, there is no convincing clinical evidence to support the claims that chronic alcoholics are at increased risk of liver damage either following overdosage of paracetamol or with its therapeutic use. Such evidence as exists is purely anecdotal and similar toxicity has been reported in both circumstances in patients who are not alcoholic.

Once absorbed, the alcohol is transported to the liver through the portal vein. 8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care. He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture. Generally speaking, everyone who mixes paracetamol and alcohol is at risk of developing side effects.

For example, the message that “acid blocker” medications can be used before or during a spicy meal to prevent heartburn symptoms may lead consumers to believe that this practice is also acceptable when they drink alcohol with their meal. In addition to CYP2E1, at least two other cytochrome enzymes that metabolize various medications (i.e., CYP3A4 and CYP1A2) also can break down alcohol (Salmela et al. 1998). Moreover, the amounts of various enyzmes of the cytochrome CYP3A family (including CYP3A4) can increase from alcohol consumption (Niemela et al. 1998). Thus, potential interactions also exist between alcohol and medications metabolized by these cytochromes. Over time, especially with excessive drinking, glutathione levels can deplete, and the liver becomes more sensitive. Mixing alcohol and acetaminophen can be considered relatively safe in small doses, but excessive dosages can cause side effects that range from mild to severe.

Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Addiction Resource does not offer medical diagnosis, treatment, or advice. Only trained and licensed medical professionals can provide such services.

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